Experimental Ebola therapies raise ethical questions

Aug. 7, 2014
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U.S. Centers for Disease Control and Prevention officials have a conference call on Ebola with CDC team members deployed in West Africa from the agency's Emergency Operations Center on Aug. 5 in Atlanta. / David Goldman, AP

by Karen Weintraub, Special for USA TODAY

by Karen Weintraub, Special for USA TODAY

Two Americans with Ebola received at least half of the world's supply of a drug that might be able to change the course of the deadly virus.

Some people are asking how to allocate additional doses of this drug and whether it was ethical to give those drugs to American missionaries when they weren't available to West Africans suffering from or fighting the outbreak.

The World Health Organization will convene a panel of medical ethicists early next week to discuss the use of such experimental treatments. The group will probably decide how to allocate medications should more become available.

The use of the drugs for the Americans alone has struck a nerve for some in Africa.

The health minister of Nigeria, one of the four countries where Ebola has broken out, told a news conference in his country that he had asked the U.S. Centers for Disease Control and Prevention about access to the drug. A CDC spokesman said Wednesday "there are virtually no doses available."

Some people in other affected countries questioned why the medicine has not been offered to infected Africans.

Anthony Kamara, a 27-year-old man riding a bicycle in Freetown, Sierra Leone, said "Americans are very selfish. They only care about the lives of themselves and no one else."

Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said earlier that the availability of the drug is quite limited. "The amount of doses that are available are literally less than a handful," Fauci said, explaining that one treatment course requires three doses of the drug. "To our knowledge, unless someone is squirreling it away, the company has about 3-4 treatment courses."

American medical ethicists said there was plenty of justification for starting the experimental therapies on the two medical missionaries, Nancy Writebol and Kent Brantly.

The two provided care to Ebola patients. In public health crises, it's standard procedure to treat "first responders" before others â?? so they can go on to help more patients, and because there is a social responsibility to help people who help others, said G. Kevin Donovan, director of the Pellegrino Center for Clinical Bioethics at Georgetown University Medical Center in Washington.

"These were people who had volunteered to put themselves in harm's way to help people who were affected by this," Donovan said. "It's not unreasonable for them to have the expectation that we would try to help them."

It wasn't clear whether the medication would be doing the two missionaries a favor â?? or reducing their chances of recovery.

The medicine, called ZMapp, made by Mapp Biopharmaceutical of San Diego, had been tested only on animals. Brantly and Writebol seem to have responded well to it, and both are recovering at Emory University Hospital in Atlanta.

The drug, created from tobacco plants in a two- to three-month process, could just as easily have hurt them.

"Harm can come from two directions: obviously from the infection, but also exposing these patients to unproven interventions," Donovan said. "Unexpected bad results do happen, which make it worse than no treatment at all."

Although Ebola can be fatal in as many as 90% of the people who catch it, mortality rates in the current outbreak are closer to 55%. Writebol and Brantly received proper care early in the course of the disease, so their odds of survival were already relatively high.

Normally, medications are developed in a lab, then tested in several types of animals, from rodents to primates, to make sure they are likely to be safe and effective in people.

It made sense to test ZMapp first on people who would have the best possible care and who could be carefully monitored for side effects and benefits, said Felicia Cohn, bioethics director of Kaiser Permanente Orange County and a clinical professor at the University of California-Irvine.

Was it the right decision to give the drug? In a situation such as this, there's no right or wrong answer, said Jeffrey Kahn, the Levi professor of bioethics and public policy at Johns Hopkins University's Berman Institute of Bioethics in Baltimore.